• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.43-50
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• 2022

Objective: The purpose of this study is to choose a treatment plan and equipment to maximize tangential irradiation to protect the normal brain tissues as much as possible during total scalp irradiation. Subjects and Methods: After zoning the total scalp of a phantom and selecting a target area for treatment, the study made a Helical TomoTherapy(HT) plan, a Helical TomoTherapy with a Complete Block(HTCB) plan, and a Volumetric Modulated Arc Therapy(VMAT) plan. All of these plans made sure that the volume of a treatment plan with 95% of a prescription dose(40 Gy) would not exceed 95% of the entire volume and that Dmax would not be more than 110% of the prescription dose. The therapy plans compared doses among organs at risk of damage including the brain. Doses in the brain tissues were assessed based on the volumetric criteria for normal tissues in Emami et al. Results: HT, HTCB, and VMAT had a dose of 21.68 Gy, 13.75 Gy, and 20.89 Gy, respectively, in brain tissues at D_33%, a dose of 7.06 Gy, 3.21 Gy, and 7.84 Gy, respectively, at D_67%, and a dose of 3.14 Gy, 1.75 Gy, and 3.84 Gy, respectively, at D_100%. They recorded a Dmean of 16.64 Gy, 11.78 Gy, and 16.64 Gy, respectively. These results show that the overall dose was low in the HTCB plan. When the volume of a low dose was calculated based on 5 Gy, they recorded 87%, 49%, and 96%, respectively, in V_5Gy. In addition, the maximum dose in the remaining organ(brain stem, hippocampus, and both lenses) except for the optic pathway was the lowest in HTCB Conclusion: The findings demonstrate that TomoTherapy with a complete block minimized a dose in organs at risk of damage including the brain and hippocampus on both sides and accordingly reduced the probability of side effects such as radiation-induced brain injuries and a resulting decrease in neurocognitive functions. In addition to total scalp irradiation, if additional studies on ring targets treated in various areas are conducted to establish the benefits of tangential irradiation, it is believed that TomoTherapy using Complete Block can be used to maximize tangential irradiation in treatment planning.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.711-714
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• 2011

Purpose: Angiosarcoma is a rare malignant neoplasm of endothelial type cells that line vessel walls. It tends to occur in aged male and the prognosis of angiosarcoma is very poor because of frequent local recurrence and early metastasis. The treatment regimen is yet to be established from its rare occurrence but the wide excision in early stage is known to be the most effective. The authors report two cases of near totally excised angiosarcoma with more than a safety margin of 5 cm. Methods: The two subjects were aged male patients, one of the two was diagnosed with angiosarcoma from our institution confirmed by the biopsy. The other one went through the wide excision with a safety margin of 2 cm and split-thickness skin graft but local recurrence was observed. The two patients underwent near total excision with more than a safety margin of 5 cm, leaving only the periosteum. After confirming that the angiosarcoma had not infiltrated the excision margin, reconstruction with split-thickness skin graft was performed. Results: Based on 6 months and 24 months post-surgery assessment, no local recurrence or remote metastasis in the lungs, liver, bones, and lymph nodes at the neck, where remote metastasis is common, was reported by the two subjects who underwent near total excision with a safety margin of 5 cm. Conclusion: Angiosarcoma has very poor prognosis from its frequent recurrence and metastasis. To enhance the survival rate of angiosarcoma patients, early diagnosis, timely surgical treatment, and radiotherapy after surgery are critical. In addition, authors suggest that it is necessary to further study the efficacy of wide excision using a wider safety margin as much as possible, and to apply this to more cases.

• Applied Microscopy
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• v.44 no.2
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• pp.47-52
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• 2014

Fine structural characteristics of eggs (nits) found on the scalp hairs of Korean children were observed with scanning electron microscopy. An egg is structurally composed of four parts: the cementum, nit body, operculum, and aerophyle. The total length of an egg is about 1.5 mm. The glue secreted from the female louse completely surrounds the 1 mm hair shaft and forms the cementum. The thickness of the cementum at the end of the nit body was found to be more than 5 times the thickness at the end toward the scalp. The nit body is shaped like a goblet with a very smooth surface. The operculum and aerophyles are located at the apiculus area. In the circular operculum, there are 10 aerophyles concentrated on the side of the hair shaft surface that are shaped like a dome. Three aerophyles in the center are surrounded by 7 aerophyles. Each aerophyle is dome shaped with a diameter of $65{\mu}m$ and a respiratory pathway with a $15{\sim}25{\mu}m$ opening at the center. On the cut surface where the operculum is separated as the egg hatches, long grooves about $1{\mu}m$ thick are uniformly formed transversely. These long grooves facilitate the separation of the operculum through body expansion at the time of hatching.

• Journal of Korean Neurosurgical Society
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• v.44 no.2
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• pp.98-100
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• 2008

We report a very rare case of a rapidly calcified chronic epidural hematoma (EDH) in a neonate. A 26-day-old female infant was referred to us from a regional hospital because of drowsy mentality and a seizure attack. She was delivered through caesarian section because normal spontaneous vaginal delivery was prolonged and failed. At birth, mild scalp swelling was found on the right frontal area. Scalp swelling was spontaneously resolved and she was discharged without any problems. On the 25th day after her birth, the baby presented with drowsiness and hypotonia following a generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) and a computed tomography (CT) scan revealed a chronic EDH that had a thick layer of calcification. A small burr-hole trephination was performed and a single silastic drainage catheter was inserted. After the operation, a total of 12 ml of liquefied hematoma was drained, and the patient's mentality improved from drowsiness to alertness. The patient was asymptomatic when discharged.

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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• pp.205-207
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• 2014

Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.89-92
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• 2011

Purpose: Electrical burn of scalp is uncommon. Much more, chronically exposed dura in unstable burn scar is quite exceptional. Hence, we report a case of chronically exposed dura following electrical burn. Methods: A 63-year-old man presented with an about 40 years history of an ulcerative lesion arising from electrical burn scar with 'squeeze like sensation' around wound. Wound was about $6{\times}8$ cm. Area in the center was $3{\times}3$ cm nonviable dura without sequestrum. Tangential excision with an intraoperative neurosurgical consultation and transposition flap under general anesthesia was done. Intraoperative biopsy was done. The wound was diagnosed as chronic osteomyelitis, not Marjolin ulcer. Flap was taken successfully. But after 5 days, infectious discharge had been appeared during 2 weeks, despite irrigation and drainage. As flap was re-evaluated, we could see remnant necrotic dura. After that, latissimus dorsi muscle free flap with meshed split thickness skin graft was transferred without excision of necrotic dura. Results: Flap was taken successfully. Follow-up at 10 weeks has been uneventful, with good and stable coverage of the wound. Conclusion: It is true that complete excision of devitalized tissue with sagittal sinus obliteration is prerequisite to flap taken. But necrotic dura was tangentially excised instead of total dura excision, because, posterior two-thirds of the sagittal sinus was involved underneath. Muscle is rich in blood vessels and decrease the recipient-site bacterial count effectively. In this case, muscle flap with skin graft without total dura excision is an alternative treatment.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.11 no.1
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• pp.31-38
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• 2013

Purpose : This study was to identify the effect of cognitive reaction following inactive electrode placement when applying anodal transcranial direct current stimulation over the primary motor cortex. Methods : For this study a total of 28 stroke patients participated. Before applying transcranial direct current stimulation, cognitive reaction was measured (P300 of event related potential, cognitive reaction time), and subjects were randomly assigned to two group. Transcranial direct current stimulation was applied to the scalp with an intensity of $0.04mA/cm^2$ for 15 minutes. All subjects were given an anode transcranial direct current stimulation over the primary motor area and inactive electrodes over the deltoid muscle (group I) and supra-orbital area (group II). Cognitive reactions were measured after applying transcranial direct current stimulation. Results : For this study a total of 28 stroke patients participated. Before applying transcranial direct current stimulation, cognitive reaction was measured (P300 of event related potential, cognitive reaction time), and subjects were randomly assigned to two group. Transcranial direct current stimulation was applied to the scalp with an intensity of $0.04mA/cm^2$ for 15 minutes. All subjects were given an anode transcranial direct current stimulation over the primary motor area and inactive electrodes over the deltoid muscle (group I) and supra-orbital area (group II). Cognitive reactions were measured after applying transcranial direct current stimulation. Conclusion : Thus transcranial direct current stimulation on the primary motor area may help cognitive reaction regardless of inactive electrode placement.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.2
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• pp.131-138
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• 2020

Purpose : The purpose of this study was to investigate the effects of the frequency band pass filter on the P300 event-related potential in the working memory. Methods : The subjects were 20 women in their 20s who applied for participation in the experiment. Event-related potentials (ERPs) were elicited using 3-back tasks for the working memory, and were recorded from Fz, Cz, and Pz scalp electrodes. The high-pass filters were set to 0.01, 0.1, and 0.3 Hz for analysis purposes, and the low-pass filters were set to 30 and 15 Hz. The 3-back task was presented for a total of 100 times, among which 30 times were designated for the target stimulation (a matched number) and 70 times for the non-target stimulation (an unmatched number). The temporal interval between each stimulation was set at 1 second, while each time duration was randomly presented between 2 to 4 seconds. ERP were analyzed for the P300 recorded from Fz, Pz and Cz scalp electrodes. Results : Latency and amplitude had no significant interaction effects in both the high- and low-pass filters. For the main effects, the latency and amplitude of the P300 event-related potential had no significant difference in the high-pass filters, but the latency had a significant difference in the low-pass filter of Fz, and the amplitude had a significant difference in the low-pass filter of Pz. Conclusion : The results of this study showed that the less than 0.3 Hz high filters had no effects on the differences between the latency and amplitude of the P300 event-related potential in the working memory. The 30Hz low-pass filter, however, was found to be useful for recording the P300 event-related potential in the working memory.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.652-663
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• 2023

Objective : This study compared the quality of recovery (QoR) after minicraniotomy for clipping of unruptured intracranial aneurysms (UIAs) between patients with and without scalp nerve block (SNB). Methods : Patients were randomly assigned to the SNB (SNB using ropivacaine with epinephrine, n=27) and control (SNB using normal saline, n=25) groups. SNB was performed at the end of surgery. To assess postoperative QoR, the QoR-40, a patient-reported questionnaire, was used. The QoR-40 scores were measured preoperatively, 1-3 days postoperatively, at hospital discharge, and 1 month postoperatively. Pain and intravenous patient-controlled analgesia (IV-PCA) consumption were evaluated 3, 6, 9, and 12 hours and 1-3 days postoperatively. Results : All QoR-40 scores, including those measured 1 day postoperatively (primary outcome measure; 155.0 [141.0-176.0] vs. 161.0 [140.5-179.5], p=0.464), did not significantly differ between the SNB and control groups. The SNB group had significantly less severe pain 3 (numeric rating scale [NRS]; 3.0 [2.0-4.0] vs. 5.0 [3.5-5.5], p=0.029), 9 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.048), and 12 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.035) hours postoperatively. The total amount of IV-PCA consumed was significantly less 3 hours postoperatively in the SNB group (2.0 [1.0-4.0] vs. 4.0 [2.0-5.0] mL, p=0.044). Conclusion : After minicraniotomy for clipping of UIAs, SNB reduced pain and IV-PCA consumption in the early postoperative period but did not improve the QoR-40 scores.

• Journal of Korean Neurosurgical Society
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• v.46 no.5
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• pp.484-487
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• 2009

It is not uncommon for hemangiomas to occur in the calvarium, accounting for about 10% of the benign skull tumors. A 46-year-old man was presented with a palpable scalp mass on the left parietal region. Past medical history indicated that he had undergone cranioplasty 25 years prior due to a depressed skull fracture suffered from a traffic accident. Magnetic resonance imaging revealed mixed signal intensity mass on T1 -and T2- weighted images pushing a linear signal void lesion outward in the left parietal region. After total surgical removal along with cranioplasty, he was discharged without neurological deficits. Histological examination of the surgical specimen revealed a cavernous hemangioma. A skull hemangioma occurring at the site of a cranioplasty has not yet been reported. Therefore, authors report this case in combination with a pertinent literature review.